Heatherfield Inn

Keep window screens clean and in repair

Based on observation, the licensee did not comply with the section cited above in that the window screens in a resident room and in a bathroom were oberved needed to repair which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

Based on observation, the licensee did not comply with the section cited above in that the fire extinguisher was observed expired which poses an immediate safety risk to persons in care.

Address and clearance obligations before facility work

Based on record review, the licensee did not comply with the section cited above in that two volunteers were observed helping residents in the facility without association with the facility which poses an immediate health, safety or personal rights risk to persons in care.

Apply centrally stored medication safeguards

Based on record review, the licensee did not comply with the section cited above in that 2 out 2 residents' centrally stored medication forms were observed inaccurate which poses/posed a potential health, safety risk to persons in care.

Submit and maintain current mailing address

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review ... shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department...This requirement is not met as evidenced by: Based on record review and interview, the Licensee did not ensure S2 obtained a Criminal Background Clearance prior to working at a licensed facility which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.

Maintain personnel records at facility location

87412 Personnel Records (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review.This requirement is not met as evidenced by: Based on record review and interview, Licensee did not maintain staff file for S2 at the facility and was not available to the licensing agency for review which poses/posed a potential health, safety or personal rights risk to persons in care.

Record centrally stored prescriptions and refill data

Based on record review, the licensee did not comply with the section cited above. R2's had 4 medication bottles were not listed in the centrally stored medication log. R1 had 1 medication bottle was not listed on the centrally stored medication records. R1 had 3 medications that had incorrect information imputed in the centrally stored medication record. This poses/posed a potential health, safety or personal rights risk to persons in care.

Based on record review and interview , the licensee did not comply with the section cited above. Resident R2 & R3 have a neurocognitive disorder. R2 physician's report is dated January 25, 2023 and Needs & services plan is date February 7, 2023. R3's physician's report is dated November 5, 2019 and Needs & Services plan is dated June 21, 2023. ADM stated she does not have updated forms. which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on interview and record review, the licensee did not comply with the section cited above. LPA's requested to review V1's health statement & Health screening documents. ADM stated she does not have V1's health statement & health screening documents. This poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

Based on observation, the licensee did not comply with the section cited above. LPA's observed in the facility backyard between both sheds had several dog droppings. ADM stated residents have activity's in the backyard as well. This poses/posed a potential health, safety or personal rights risk to persons in care.

Ensure hazardous items are locked and not unattended

Based on observation, the licensee did not comply with the section cited above. LPA observed that behind the shed, closest to the deck, had several tools and a red container of gasoline. LPA's also observed behind the shed closest exit #3 had a container of lighter fluid. This poses an immediate health, safety or personal rights risk to persons in care

Maintain physician order documentation in resident record

Based on interview and record review the licensee did not comply with the section cited above. LPA observed 4 Out of 5 residents beds had half side rails. LPA requested to see the doctors orders for the bed rails. ADM stated she didn't know she had to get a doctors order for the half side bed rails. This poses/posed a potential health, safety or personal rights risk to persons in care.

Certified administrator requirements and substitute coverage

87405 Administrator - Qualifications and Duties (a) All … The administrator shall … shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility … fulfill his/her responsibilities ... This requirement was not met as evidence by: Based on record reviews and interviews conducted, the ADM is not spending 20 hours a week in the facility Monday-Friday, during working hours, 8am-5pm. This poses an immideate safety and health risk to residents in care.

Maintain facility in clean, safe, sanitary condition

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include ... for the safety and well-being of residents, employees and visitors.This requirement was not met as evidenced by; Based on LPA's observation, bedroom #4's screen door has holes and is not in good repair. ADM confirmed that the screen door is damaged as well. This poses/posed a potential health, safety or personal rights risk to persons in care.

Based on record review, the last drill conducted was on July 17, 2023. This poses/posed a potential health, safety or personal rights risk to persons in care.

Living accommodations aligned with facility function

Based on interviews conducted with S2, S2 stated he/she sleeps in bedroom #3 with resident R2. ADM confirmed that S2 was sleeping in bedroom #3. This poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain personnel records at facility location

Based on record review and interview, the facility did not have personnel records at the facility. ADM stated she has staff records on her computer but due to hard drive issue, it needs to be repaired, so its currently not available. This poses/posed a potential health, safety or personal rights risk to persons in care.